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Case Study

Learn a Remedy through Cases: Crotalus-cascavella
Complied by:
T K Kasiviswanathan

The venom of this Brazilian rattlesnake (Crotalus-horridus is a rattlesnake of North America) in potentised form, produces a magnetic state wherein the patient feels that his intellectual faculties and his personal power are increased. He is extremely sensitive to sensual impressions. The patient experiences an element of fright with no apparent reason. This quality makes it as one of the most hypochondria snake remedies. The following rubrics clarify:

Death thoughts of, alone, when;
Delusions, footsteps, hears behind him people; behind him, someone is; walks behind him someone; skeletons, sees;
Specters, ghosts, spirits, sees; death appears, as a gigantic black skeleton; hears voices; hears voices he must follow; groans, he hears.
Dreams, frightful; Fear, night; fear, alone, of being; fear behind him, that someone is;
Fear, death of; fear ghosts, of; starting, sleep during.
Sadness, despondency, dejection, depression, gloom and melancholy

Case 1:
Mrs S P, aged 34, consulted Dr Rajan Sankaran for low-grade evening fever with chilliness followed by sweating; headache extending from right to left with heaviness in occiput and pain in legs in the evening; could sleep only with tight bandage.

During consultations some mental symptoms came up prominently- violent rage at least provocation and often without any apparent cause. When angry, she would beat her children severely till exhausted. Once, when upset with husband playing cards with his friends, she went in a fit of rage and threw a heavy stone, injuring one friend. Later, she was repentant. Her body is hot when angry; also many times in the last 6 years, she fell unconscious then. She is very sensitive to noise, which causes palpitation. The main reason for her anger was that her husband and in-laws have squandered all their wealth and also her dowry, through drinking and gambling. Quarrels with husband were on this only; on two occasions she even tried to commit suicide.

She suffers from many hallucinations: in sleep, someone calls out and if she replies, it comes out and chokes her, causing numbness over her whole body. At times, she sees a lady lying next to her husband; a dark lady who steals rice from her house. Also dreams of being chased by a tiger and a man with a club. She is pushed by a man from top of the mountain and she gets stuck midway and a five-headed snake.

Rajan Sankaran analyzed the basic themes of snakes in this case as under:
Pursued, persecuted, deceived, jealous, amorous. Choking/ suffocation. Danger

Delusion, some one is behind him; fear someone is behind him. Del hears footsteps behind him; suicidal disposition and fear of death.
He selected Crotalus-cascavella as that remedy has marked hallucinations. 200thpotency one dose was given. In the first follow-up the patient said that she had improved and her anger was much less; she was not angry when her son broke a jar containing sugar. (Further follow-ups are not given but it is clear that this remedy was appropriate) This remedy does not appear in the rubric Anger in the Repertory (since it is not a well-proved remedy) but we know from common folk-lore that snakes get angry when provoked.
-Rajan Sankaran, Substance of Homoeopathy

Case 2:
Ms DM, 33y, consulted Dr Deborah Gordon for a variety of complaints. Renal failure from use of Lithium; high BP. She is emotionally very depressed with suicidal tendencies. Gets violently angry easily, then cannot sleep for which she had to be hospitalized. Hears noises in her head.

Past History: viral pericarditis at age 12, pneumonia as an infant; gall bladder was removed 7 years back. She had depression due to birth control pills.

Life situation revealed that she had to endure sexual abuse from step-father’s father and also from an outsider. She thus had mental and emotional illness, bipolar, PTSD and stress complicated by sleep disorder, in association with iatrogenic renal failure with secondary anemia and hypertension. At her first visit her symptoms were well controlled by allopathic medicines and she looked mild mannered and pleasant. The doctor, underestimating the seriousness of the pathology, gave her Staph 1M, based on the history of abuse and suppressed anger.

When she showed up for the first follow-up, she said that "I am not able to sleep; have suicidal tendencies and I want to shoot myself or cut myself or take pills. I feel life is not worth living. I want to avenge those who have hurt me and want to chop my stepfather. Death could be a relief. She was given Aurum because of her suicidal tendencies with strong anger component. While her BP improved, her physical symptoms such as heart pain (She was to undergo angioplasty earlier), pneumonia and cholecystitis did not improve. She was hospitalized for cardiac evaluation; she was given antibiotics for her pneumonia. She was given Hepar-sulph, Lachesis, Cenchris-contortrix and Lyssin without any lasting improvement. One year later she said that she was having hallucinations- insects and snakes crawling on her during her aggravations. She was also occasionally joking. Crotalus-cascavella has such a hallucination of snakes and insects. The doctor also took note of the observation of Rajan Sankaran in a case of this remedy (Case No 1) where the patient would get into violent rage at the least provocation causing actual destruction like the rattlesnake. The doctor could now decide on this remedy. Additional relevant rubrics were:

Mind: Dreams: spiders, enormous, hairy which tried to climb on him;
Mind: Dreams: vermin;
Mind Anxiety, chest in;
Death, thoughts of, alone when;
Mind: alternating with groaning; Mind: suicidal disposition, throwing himself from windows. 
Additionally the remedy has this rubric Mind: violent deeds of rage, leading to (I could not find it in Synthetic or Robin Murphy’s Repertories) as was stressed by Dr Rajan. (This is the second case of this remedy where such anger was detected and can be treated as a clinical symptom and concomitant).

She was given Crotalus-cascavella 200 one dose and 12C daily. After the medicine she saw the snakes constantly in dreams and also in daytime and later that hallucination subsided; she had a lot of flashbacks of her abuse. Since then she had several ups and downs in her conditions including several acute illnesses for which she was given acute remedies. Throughout treatment, she was free from hallucinations and suicidal impulses. When there was a serious relapse of her symptoms due to suppression during acute illnesses she was again given another dose of the same remedy in 200th potency and she responded well. After three years of treatment she went back to work but developed intermittent rectal bleeding and blood in urine. This discharge was a favourable sign but because of the seriousness of her pathology she was administered 1M potency of the drug. Her bleeding stopped. Her BP was in control with medication. Gradually she became normal.

There are many instructive points in this case, as pointed out by the author. She was in fact given two snake remedies (Lachesis, Cenchris-contortrix) without much improvement. Her psychotic depression dramatically changed when she was prescribed Crotalus-cascavella. When the upper layer was removed the latent serious pathology asserted itself which had to be treated and when the mental symptoms returned this remedy had to be repeated resulting in rectal bleeding. The homoeopathic remedies were administered while she was still taking allopathic drugs, which were suppressive. Once the correct remedy was given the allopathic remedies did not seem to interfere with the action of her constitutional remedy.(Homoeopathic Links 4/97). Dr Sehgal used to say that when the correct similimum is administered there will be a discharge which is healthy and the process to cure.

Case 3:
Dr Rajan Sankaran presented another case of a 46-year-old woman who consulted him for severe joint pains and asthma. History revealed two sides -one thinking that there is no one like her and the other has the feeling that she is being pursued and troubled. She was loquacious but her talk was wandering; talks as though she were two persons instead of one. On the one hand, she wanted her family to be happy and on the other, she did not care; pessimistic and negative in outlook, feels nothing will work- her daughter’s marriage will not work out and her investments will fail. Her main feeling is that people do only negative or bad things to her. She can only see the negative side in things; constant feeling of hopelessness. She is always fearful that because she is on top of the world people are there to finish her. She is afraid of dark and has the feeling that there is someone behind her to grab and kill her.

Initially she was given Lachesis because of her loquacity, wandering speech; antagonism with herself, jealousy etc but it did not fully meet the case. Dr Rajan then had a group consciousness session with a few colleagues and based on the dreams experienced by the participants he selected the following rubrics:-
1. Delusion, people sees, behind him someone is.
2. Thoughts of death when alone and
3. Thoughts of murder
. On the basis of these she was given Crotalus-cascavella,which in infrequent intervals cured her. (System of Homoeopathy)

Case 4:
A woman consulted Dr Yogesh Vasandi for the following complaints. Blisters in the mouth with inflamed tongue; insomnia for some days. Eruptions spreading in a circular fashion in the right hand; swelling and pain in the Rt leg < exertion and getting wet. She also complained of depression. She added that she heard footsteps in her room in the night and that someone woke her up; invariably she woke with a jerk from sleep and was scared and did not know why. Fear of death. She did not reconcile to her father marrying again after her mother’s death and there were strained relations with her stepmother. She felt that her stepmother ill-treated her and incited quarrels between her and her father. Her sisters seemed to have compromised and sided with their stepmother. "I feel neglected and lonely in my own house. The atmosphere in my house depresses me. As long as I am outside my home I feel good, but the moment I enter my house I feel surrounded by something, a depressing influence envelops me", like a magnet attracting iron filling. Felt ill treated, persecuted. All her problems started after she decided not to retaliate to her stepmother. Now she wanted to become thin and for that she was exercising like a maniac. On further questioning she said that tight clothes around her neck and waist aggravated.

KR 26: Delusion footsteps, hears;
KR17: Death, thoughts of, alone when;
SRI389: Desire for exercise;
KR 75: sadness, despondency, dejection, gloom, mental depression;
KR 83: Starting during sleep; Fear night alone of being;
KR 406: Magnetic state;
K401: Inflammation of tongue

The other physical complaints such as discolouration of tongue, pain in tongue, swelling of forearm and eruptions were also taken into account for repertorisation.
The patient was given Crotalus-cascavella 1M. After one week all her complaints were less by 60%; No eruptions during menses. There was a slight relapse after 1 ½ months and remedy repeated in same potency. In the fourth month there were episodes of going blank and panic attacks and weakness and trembling of limbs. Remedy repeated. By the 8th month her tongue became normal and there was no pain in her legs; her relations with her stepmother improved and other symptoms ameliorated.

Dr Vasandi points out that during the time she was under the delusion of being wronged and persecuted and neglected, there was no physical illness. When she decided to improve her relations with her stepmother all her suppressed emotions resulted in pathology. In her it was the tongue and emotions and skin. Her symptoms are common to most snake venoms. But the peculiar symptoms clinched the remedy. One of the symptoms of this remedy in Clarke’s write up is magnetic state and see how the patient described her feelings when she came into the house ie depressing influence was attracted to her like a magnet.
Yogesh Vasandi- Homoeopathic Links 3/96

Case 5: I think of death when alone
A 21-year-old woman consulted the doctor for her nervous tension, sleeplessness, and cramps in her stomach. During the interview she said that she was afraid to be alone after her sister got married. Since childhood she was constantly thinking of death and about what happens after death. She also said that she felt things or developments, which later came about (clairvoyant). She also had fear of death of self and her pets. She had a dry mouth and complained of stomachache and coldness of feet. She talked a lot but her thought pattern was confused. Crotalus-cascavella was prescribed in 30th potency based on the following rubrics:
SRI 199: Death thoughts of
SRI 488: Fear, death of,
SRI 141: Clairvoyance
Mouth dryness
SRIII: extremities, coldness of foot, icy cold
SRI713: Loquacity
SRI 936: Speech confused

She reported after 3 months that she was sleeping better; no stomachaches; fears less and less frequently worried about her death or her loved ones. She said that she woke up tired and also her headaches, which she had previously, returned. The remedy was repeated in the same potency. On a review after 7 months the patient said that her headaches were gone. Was sleeping better and no clairvoyant dreams of death of known persons. She was thinking less about death and hence she could sleep better and less stressed.
Massimo Mangialavori, Homoeo Links 3/96

Case 6:
patients see their hallucinations in vivid black, whether skeletons, ghosts or snakes. Here is a case, which brings out this aspect very clearly.

A lady, 35 y, consulted Dr Chetna Shukla for obesity, pain in her legs and acidity. The acidity arose because of her fondness of eating food outside home and spicy and sweet foods. She is methodical and gets upset and angry when she is interrupted and does not talk to the person for a few days. She will also not allow anybody to overtake her car. During her second pregnancy, she had a persistent fear that something would happen to her and she would lose her child. Because of such thoughts she could not sleep well at night. After delivery she had heavy bleeding and hence had to undergo hysterectomy. At that time she felt certain she would die. She also had a hallucination that somebody dressed in black was sitting on her chest as a heavy load. "Very often I feel somebody is coming to strangulate me and I cannot move and cannot even speak or call anyone and my body turns cold. There are some persons who are all dressed in black and surrounding me."She had also dreams of person dressed in black and chasing her up the hill but he never catches her in those dreams. Also dreams of black snakes. She also had a fear of dark being alone from childhood and would not go out alone after 7PM. She is very talkative. She cannot tolerate summer and feels suffocated; she cannot wear anything tight around her neck and also tight clothes.

The remedy is clear and that is Crotalus-cascavella. In particular, her hallucination of seeing persons dressed in black trying to strangulate her is well covered by the rubric SRI 354-55: Mind: Delusion: Spectres, ghosts , spirits sees. Death appears as a gigantic black skeleton.

The remedy was given in 1M potency and a little later she developed rhinitis which stopped after a week; all other complaints were ameliorated; her fears were less and she was bold enough to come to the clinic alone; her acidity was also markedly reduced. After one year there was return of some of her complaints for which the remedy was repeated in same potency and she was better.
Dr Chetna B Shukla, Homoeopathic Links 4/99

Case 6:
An eleven-year-old girl started having pain in her left hip and later there were severe wandering pains in her joints. She was crying because of severe pain and was very depressed. The pains were coming in waves and were < evening and > by warm bath. She felt that she had no bones in her feet and when standing had a feeling that one leg was shorter than the other; medical examination showed no pathology. Her dreams were peculiar: A black cat came to her bed and asking her to sit on its back and when she sat, the fur of the cat turned into pins. She had fear of thunderstorm and darkness. In the darkness she had the delusion that skeletons came into her bedroom. She slept uncovered on her left side and is very warm and refused warm clothes with strong perspiration on her feet. She desired cold things. She was clairvoyant and foresaw the death of a woman acquaintance a fortnight earlier and was inconsolable when the person died.(see case no5)

When one has studied the earlier cases the remedy will be very clear and it is Crotalus-cascavella. Dr Clarke says "sensation as if right hip from hip to heel was shortened." The patient complained of shortness of one leg as compared to the other. She was given one dose of it in 30th potency. Her joint pains in her arms and legs initially increased and later were less and she could sleep better. The next day the pains came but were weaker and since then she did not complain of such pains.
Dr Viktor B Jenni- Homoeopathic Links 3/95

Case 7:
A woman consulted Dr Jayesh Shah for her endometriosis with chocolate cyst of ovaries and profuse menstruation. The case history revealed several rich mental symptoms of this remedy. The first symptom, which struck the doctor, was "Clairvoyance" (see the two earlier cases). She was a great devotee and dreamt that her Guru was predicting what would happen. She dreamt that Guru was telling her that he would be visiting her house and in fact he arrived at her house next day. This also gives another rubric -magnetized; she was afraid to be alone and was very much dependent on her guru and also on her husband. When walking she had a feeling as if somebody was following her or pursuing her. From the two rubrics of Clairvoyance and fear of being alone, the remedies emerged were Crotalus-cas, Hyos, Lyss, Phos, Stram, Taren.

The lady had other symptoms and delusions: Delusion, hears footsteps behind her; Delusion hears voices, fancies, someone is behind him; moaning during sleep; sadness can’t weep. These symptoms clinched the remedy Crotalus-cascavella, which was given in varying potencies. It removed not only her menstrual troubles but she also stopped dreaming of her guru and fear of being alone was also less.

Report on the seminar of Dr Jayesh Shah in Homoeopathic Links 2/92

Case 8:
A 29-year-old woman consulted Dr Prashant Shah for her sinusitis, worse in winter and damp weather, excessive weakness in the morning and loss of weight. She had poor appetite; desired sweets with great unquenchable thirst. She had a history of appendectomy and laparotomy arising from complications from the use of copper T. During consultation, she said that when alone she had a constant feeling that someone was behind her. On seeing a horror show she felt that it was happening to her and hence was terribly frightened. At night she has a delusion that someone was moving around her bed and the patient was afraid to sleep because of the fear that person would get on top of her. Her housemaid had committed suicide and she felt that she was the spirit, which was visiting her at night. She cannot therefore sleep alone in the night. She had dreams of ghosts and ghost coming behind her. She said that she was very sentimental and even very small things could bring tears to her eyes.

She was constantly opening and closing her purse (Gestures, plays with her fingers) and said she felt choked when she wore some jewellery around her neck.

The mental make up of the patient corresponds to that of Crotalus-cascavella, which relieved her complaints greatly.
Dr PRASHANT Shah, Homoeo Links 2/97

DD: Both Crotalus-cascavella and Elaps (another snake remedy) have fear of being alone; Elaps wants to get away into the countryside while Crot-cascavella loves bustle, crowds and activity. The more commonly used snake remedy Lachesis has more hidden deceit and overt jealousy. More intense competition. Dr Jayesh Shah

Compare Mancinella, which also demonstrates lot of fear similar to Crotalus-cascavella. In Mancinella, however, these manifest on the skin, whereas in Crotalus-cascavella they manifest as neurological affections. Dr Farokh Master